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General NPI Number Information
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NPI Number | 1487189031
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Entity Type | Organization
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Legal Business Name | FUNCARE
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 2048 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1889
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Country | US
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Telephone | 734-629-4315
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Fax |
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Provider Business Mailing Address
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Address Line | 3395 CREEKS BEND CT
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City | CANTON
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State | MI
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Zip | 48188-2386
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Country | US
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Telephone | 734-834-9937
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Fax |
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Authorized Official
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Title or Position | OWNER THERAPIST
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Name | DARNELL C DANIELS
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Credential | LLPC
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Telephone | 734-834-9937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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